Democratic presidential hopeful Sen. Bernie Sanders (I-VT) released a new version of his Medicare for All bill on Wednesday, keeping true to form by championing one of the most ambitious health policies in the country. So far, the proposal has the support of more than a dozen Democrats, including fellow 2020 candidates Sens. Kirsten Gillibrand (NY), Kamala Harris (CA), Elizabeth Warren (MA), and Cory Booker (NJ).
The Sanders bill expands the traditional Medicare program, by covering all U.S. residents and adding extra benefits, with no premiums and minimal out-of-pocket costs. The idea is for everyone to get health care through a single government-run program instead of today’s patchwork system, thus abolishing virtually all private insurance. The big difference in Sanders’ new bill is its benefits package is even more robust than before.
But as Sanders continues to push his very bold idea — one that’s really changed the way Democrats talk about health care — he still hasn’t provided satisfying answers to critical questions about how to get it done, be it financially or logistically.
Notably, Sanders re-introduced his bill without including a section on funding. As he did when he introduced his bill in 2017, Sanders released a separate white paper with some finance options, including raising marginal income tax rates, making the estate tax more progressive, and savings from health tax expenditures. But the white paper stresses the country is already paying for Medicare for All — it’s just moving the financial burden from consumers to the federal government.
Economists are still in disagreement on whether Medicare for All decreases overall health spending, as the proposals thus far are vague on key points.
The funding here is critical. Like the previous version, Sanders’ bill covers prescription drugs (with a copay of up to $200) and dental care. But the new bill also includes long-term care, which encompasses a wide array of medical and personal care services from nursing homes to transportation. Long-term care is expensive. The average cost for a single person over their lifetime is $172,000, and the national cost is expected to double to $5.6 trillion by 2047.
Currently, the primary payer of long-term care is Medicaid, a program that conditions eligibility on income, as it is designed for people who earn below or near the poverty level. But Medicaid doesn’t automatically cover community-based services, such as home health aides, even though institutional care far exceeds the costs of living at home.
The Sanders bill addresses the federal government’s institutional bias by including home- and community-based services under the Medicare for All plan and institutional care under Medicaid. Sanders would have the United States go further than Canada, a country he always praises as doing right on health care. Long-term care isn’t a mandatory benefit nationwide in Canada, and there is considerable variation across provinces.
The last Sanders bill left long-term care entirely to Medicaid, which upset many disability rights activists who argued that the status quo isn’t working for them. Indeed, over 470,000 people nationwide are waiting for Medicaid to pay for them to live independently at home.
“The inclusion of home- and community-based services is a nod to the importance of long-term services and support and we would hope that as different versions of the bill come forward, there is a more robust long-term services and support benefit,” said Nicole Jorwic, the director of rights policy at the Arc, an advocacy group for people with intellectual and developmental disabilities.
Jorwic, who is also affiliated with the Consortium for Citizens with Disabilities, says the Arc was among several advocacy groups that met with Sanders’ staff about his Medicare for All bill. She’s grateful Sanders revised his bill, but maintains that the long-term benefits package in health reform bills on the House side are more robust — namely, the Medicare for All bill introduced by Rep. Pramila Jayapal (D-WA) and the Medicare for America bill introduced by Reps. Rosa DeLauro (D-CT) and Jan Schakowsky (D-IL). Both House bills cover community- and institutional-based care without cost-sharing.
Sanders should be credited for moving Democrats toward single-payer. He championed Medicare for All during the last presidential election cycle, and support for the idea has since grown. Sen. Jeanne Shaheen (D-NH) is the only person still in office who backed the Sanders bill in 2017 and has withdrawn her support. Shaheen said in a statement to ThinkProgress that she believes there are faster ways to get to universal coverage, and stressed the importance of “building on the progress we’ve made through the Affordable Care Act.”
Sanders is skeptical of abolishing Senate rules that make it especially challenging for lawmakers to pass any ambitious Democratic proposal, including his own health care bill.
Few Democrats running for president support getting rid of the filibuster, the 60-vote threshold for moving legislation that isn’t budget-related to a final vote. Only Warren, South Bend Mayor Pete Buttigieg, and Washington Gov. Jay Inslee have called to abolish the filibuster. (The Senate eliminated the filibuster for cabinet officials and federal judges in 2013, and later for Supreme Court justices in 2017.)
“Donald Trump supports the ending of the filibuster. So you should be a little bit nervous if Donald Trump supports it,” Sanders told HuffPost on Monday. The senator said he’s confident progressive bills like his could pass through the existing setup.
But it’s hard to imagine a scenario in which even a Democratic-controlled Congress passes Medicare for All legislation with 60 votes. It’ll also be challenging, if not impossible, to pass his legislation through reconciliation, the legislative maneuver Senate Republicans used to try to pass their health bill in 2017 (they failed). That’s why more and more progressives are calling on candidates who support Medicare for All to also support abolishing the filibuster.
Jorwic isn’t asking Sanders to support abolishing the filibuster. Although she’s under no illusion that the long-term care benefit will persuade Republicans to support the Sanders bill, Jorwic says it does make it more palatable, at least to Republican voters.
A lot of people need long-term care. Roughly 70 percent of people age 65 and over will use this benefit, and people ages 85 and over — the fastest-growing group in the United States — are four times more likely to need it, according to 2012 figures. It’s clear the current system isn’t working, she said, because if people aren’t eligible for Medicaid, then they’ll likely pay out-of-pocket for this care.